Care planning is the foundation of the nursing process. Compared to the 1.4 million persons served by nursing facilities in 1995, today's average nursing facility resident is older and frailer, more acutely ill, and more impaired. Comprehensive, individualized care plans are essential in meeting their needs. In 1999 21 percent of nursing facilities nationally were cited for general quality of care deficiencies, 13.4 percent for poor resident assessment, and 16.1 percent for failure to provide a comprehensive care plan. Regulations resulting from OBRA 1987 defined a Minimum Data Set (MDS) and specific tools to standardize care planning in nursing facilities. Nonetheless, our preliminary studies indicate that the integrity of the care planning process varies across facilities in regard to several elements likely to impact its quality and efficiency. We propose to (1) examine facility care planning processes for differences in centralization, interdisciplinary team, leadership, integration, and rehabilitation perspective; (2) identify the associations between the characteristics of the care planning process and resident outcomes (weight loss, falls with injury, pressure ulcers, urinary tract infections, and behavior that affects others); (3) estimate the costs and assess the efficiency of care planning; and for, a subsample of facilities, (4) analyze the associations between the elements of care planning integrity and resident, family, and staff satisfaction. The sample will be 100 randomly selected Kansas and Missouri nursing homes. Primary data about care planning will be collected via telephone interview with key staff from each facility. Other variables will be obtained form KS and MO administrative databases-MDS, OSCAR, and Medicaid Cost Report. Twelve facilities will be selected for onsite collection of resident, family and staff satisfaction data. Data will be analyzed using multi-level structural equation modeling procedures, data envelopment analysis, stochastic frontier estimation, and mixed model variance component analysis. The findings regarding the elements of care planning integrity that result in the most positive outcomes for residents at the lowest cost to the facility will drive the development of new strategies to improve care.